Fillable NOTICE OF OWNERSHIP CHANGE (Kansas Department of Revenue)

Fill Online, Printable, Fillable, Blank NOTICE OF OWNERSHIP CHANGE (Kansas Department of Revenue) Form

Use Fill to complete blank online KANSAS DEPARTMENT OF REVENUE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

NOTICE OF OWNERSHIP CHANGE (Kansas Department of Revenue)

On average this form takes 31 minutes to complete

The NOTICE OF OWNERSHIP CHANGE (Kansas Department of Revenue) form is 2 pages long and contains:

  • 1 signature
  • 26 check-boxes
  • 108 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Kansas Department of Revenue forms online.

BROWSE KANSAS DEPARTMENT OF REVENUE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Licensee DBA Name
Location Street Address
Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9th Street, 5th Floor
Fax: 785-296-7185
PO Box 3506
Kdor_abc.email@ks.gov
Topeka KS 66601-3506
www.ksrevenue.org/abc.html
NOTICE OF OWNERSHIP CHANGE
All entity types, except Class A Clubs and Individuals, must complete and submit this form when there are any changes in the ownership and your FEIN remains the
same. If your FEIN will change, you must complete and submit the ABC-800 Application for Liquor License.
SECTION 1 – LICENSEE INFORMATION:
FEIN
License Number
City State County Zip Code
Phone Number
Email Address
The following information must be provided on the applicant(s); partners; all officers and directors (if a corporation of LLC); and anyone with a financial
interest, AND the spouses of all submitted persons (attach additional pages as necessary). The percentage(s) of ownership must total 100%.
SECTION 2 – NEW OWNERSHIP INFORMATION:
Last Name First Name Middle Name Gender Date of Birth
Social Security Number Driver’s License Number DL State % Ownership
Current Residential Address City State County Zip Code Daytime Phone
☐
☐
Marital Status:
Married (complete spousal information)
Single
E-mail Address
Spousal Information
Last Name First Name Middle Name Gender Date of Birth
Social Security Number Driver’s License Number DL State % Ownership
Current Residential Address City State County Zip Code Daytime Phone
Last Name First Name Middle Name Gender Date of Birth
Social Security Number Driver’s License Number DL State % Ownership
Current Residential Address City State County Zip Code Daytime Phone
☐
☐
Marital Status:
Married (complete spousal information)
Single
E-mail Address
Spousal Information
Last Name First Name Middle Name Gender Date of Birth
Social Security Number Driver’s License Number DL State % Ownership
Current Residential Address City State County Zip Code Daytime Phone
Last Name First Name Middle Name Gender Date of Birth
Social Security Number Driver’s License Number DL State % Ownership
Current Residential Address City State County Zip Code Daytime Phone
☐
☐
Marital Status:
Married (complete spousal information)
Single
E-mail Address
Spousal Information
Last Name First Name Middle Name Gender Date of Birth
Social Security Number Driver’s License Number DL State % Ownership
Current Residential Address City State County Zip Code Daytime Phone
ABC-809 (Rev. 08/19) Page 1 of 2
☐
Yes
☐
No
☐ Yes ☐ No
☐
Yes
☐
No
☐ Yes ☐ No
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
State:
:
☐
Yes
☐
No
☐
Yes
☐
No
☐
Yes
☐
No
Alcoholic Beverage Control
Phone: 785-296-7015
109 SW 9th Street, 5th Floor
Fax: 785-296-7185
PO Box 3506
Kdor_abc.email@ks.gov
Topeka KS 66601-3506
www.ksrevenue.org/abc.html
FEIN
SECTION 3 – BACKGROUND QUALIFICATIONS:
If the answer to any question is yes, provide explanation on separate page and attach to the form.
1. Has any person listed in Section 2 been convicted of a felony in Kansas, in any other state, or under federal law?
2. Has any person listed in Section 2 been convicted of a morals charge (prostitution; procuring any person; solicitation of a chil
d
u
nder 18 for immoral act involving sex; possession or sale of narcotics, marijuana, amphetamines or barbiturates; rape; incest
;
g
ambling; adultery; or bigamy) in Kansas or any other state
?
3. Has any person listed in Section 2 ha
d an alcoholic liquor or cereal malt beverage license revoked in Kansas or in any state?
4. Is any p
erson listed in Section 2 currently a law enforcement officer or non-elected official who supervises or appoints any law
e
nforcement officer
?
5. Does
any person listed in Section 2 have an ownership interest in any other business licensed to sell alcoholic liquor or cereal malt
b
everage in Kansas or any other state? If so, please provide license number and state of issu
e.
L
icense Number:
6
. Does any person listed in Section 2 not meet the Kansas residency requirement for the type of license applied for?
(Cla
ss A & B Club, Drinking Establishment – 1 year; Farm Winery, Microbrewery or Microdistillery – must be
Kansas resident; Retailer – 4 years; Manufacturer – 5 y
ears)
7. Is any person listed in Sections 2 not a US Citizen? If yes, explain
SECTION 4 – REQUIRED DOCUMENTATION:
I have attached a copy of the meeting minutes reflecting changes in officers and ownership.
I have attached a copy of the purchase agreement for the ownership change.
I have attached a Financial Disclosure
(form ABC-801) with supporting documentation, disclosing the source of funding to
purchase all or part of the entity.
Under penalties of perjury, I declare the information contained in this document a true, accurate and complete disclosure of information.
Licensee/Agent Signature Date
ABC-809 (Rev. 08/19) Page 2 of 2
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

NOTICE OF OWNERSHIP CHANGE (Kansas Department of Revenue)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document